Provider Demographics
NPI:1083393904
Name:BURNS, LAWANDA
Entity Type:Individual
Prefix:
First Name:LAWANDA
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 LACROSS RD
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-8206
Mailing Address - Country:US
Mailing Address - Phone:229-815-9348
Mailing Address - Fax:
Practice Address - Street 1:259 LACROSS RD
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-8206
Practice Address - Country:US
Practice Address - Phone:229-815-9348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA376K00000X
GA050931542172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No376K00000XNursing Service Related ProvidersNurse's Aide